| NPI | 1972522282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL ME181380) |
| Additional Taxonomies | 2086S0129X (Licence: NH 17053) |
| 2086S0129X (Licence: MA 80230) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2026-06-01 |