| NPI | 1982364535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156F00000X Technician/Technologist (Licence: FL TN52013) |
| Additional Taxonomies | 156F00000X Technician/Technologist (Licence: NV 65629-TCL-0) |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2021-12-22 |