| NPI | 1952555666 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086S0129X  (Licence: TN 51677)  | 
| Additional Taxonomies | 2086S0129X  (Licence: AR E11572)  | 
| 2086S0129X  (Licence: MS 25809)  | |
| Enumeration Date | 2008-11-07 | 
| Last Update Date | 2025-01-22 |