| NPI | 1972980761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PA MD458381) |
| Additional Taxonomies | 2086S0129X (Licence: VA 0101264568) |
| 2086S0129X (Licence: SC 87875) | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2025-05-22 |