| NPI | 1962488296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: DC 19675) |
| Additional Taxonomies | 2085N0700X (Licence: MD D0043405) |
| 2085N0700X (Licence: DE C10005594) | |
| 2085N0700X (Licence: OH 35073983P) | |
| 2085N0700X (Licence: PA MD063975L) | |
| 2085N0700X (Licence: TX K6242) | |
| 2085N0700X (Licence: VA 0101051960) | |
| 2085N0700X (Licence: CO 42667) | |
| 2085N0700X (Licence: FL ME94156) | |
| 2085N0700X (Licence: HI MD12067) | |
| 2085N0700X (Licence: IA 32293) | |
| 2085N0700X (Licence: MO MD114753) | |
| 2085N0700X (Licence: NM 2001-281) | |
| 2085N0700X (Licence: NY 5206088) | |
| 2085N0700X (Licence: NV SP090) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2013-02-15 |