| NPI | 1932151420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MI EMC0005666) |
| Additional Taxonomies | 2085R0001X (Licence: KY 54956) |
| 2085R0001X (Licence: AL 44181) | |
| 2085R0001X (Licence: OH 35.053637) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2025-06-03 |