| NPI | 1841587094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: UT 9452763-1205) |
| Additional Taxonomies | 2085R0001X (Licence: ID M-12990) |
| 2085R0001X (Licence: CA C170527) | |
| 2085R0001X (Licence: WY 10732A) | |
| 2085R0001X (Licence: IL 125059011) | |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2026-04-14 |