| NPI | 1851592687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: FL ME92589) |
| Additional Taxonomies | 2085R0001X (Licence: MN 70324) |
| 2085R0001X (Licence: WI 71952-20) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2026-04-14 |