| NPI | 1932115987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX F9394) |
| Additional Taxonomies | 2086S0129X (Licence: AR R-3908) |
| 2086S0129X (Licence: SC 35233) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-09-01 |