| NPI | 1942525423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: KS 04-53001) |
| Additional Taxonomies | 2085R0001X (Licence: WA BC60500955) |
| 2085R0001X (Licence: CA A114416) | |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2026-05-15 |