| NPI | 1922114826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: AZ 55113) |
| Additional Taxonomies | 2085R0001X (Licence: WA MD61258655) |
| 2085R0001X (Licence: ME MD19224) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2023-05-08 |