| NPI | 1952757452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: IL 036179083) |
| Additional Taxonomies | 2086S0129X (Licence: MN 69229) |
| 2086S0129X (Licence: TX U2389) | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2026-08-05 |