| NPI | 1902124936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NE 28713) |
| Additional Taxonomies | 2085R0001X (Licence: AZ 77184) |
| 2085R0001X (Licence: FL ME115171) | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2025-09-09 |