| NPI | 1841344595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: VT 042.0012626) |
| Additional Taxonomies | 2080H0002X (Licence: NH 16051) |
| 2080H0002X (Licence: NY 225027-1) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2020-02-25 |