| NPI | 1891792941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: AZ 37785) |
| Additional Taxonomies | 2085R0001X (Licence: HI 14370) |
| 2085R0001X (Licence: TX K7259) | |
| 2085R0001X (Licence: PA MD-054897-L) | |
| 2085R0001X (Licence: KS 04-26168) | |
| 2085R0001X (Licence: LA 14269R) | |
| 2085R0001X (Licence: GU M-1541) | |
| 2085R0001X (Licence: AR E-13744) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2023-02-02 |