| NPI | 1962473751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MO 2013012262) |
| Additional Taxonomies | 2085R0001X (Licence: IL 036-104163) |
| 2085R0001X (Licence: CA A78262) | |
| 2085R0001X (Licence: IN 01067637A) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2024-03-11 |