| NPI | 1871663401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: TX F2418) |
| Additional Taxonomies | 2085R0001X (Licence: WV 29878) |
| 2085R0001X (Licence: CA G29884) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2026-06-02 |