| NPI | 1891759692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: VA 0101052951) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101052951) |
| 2085R0001X (Licence: TN 65949) | |
| 2085R0001X (Licence: PA MD475884) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2026-02-18 |