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 |