| NPI | 1992720601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: SC 27665) |
| Additional Taxonomies | 2086S0129X (Licence: MA 218312) |
| 2086S0129X (Licence: PA MD460145) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2026-03-16 |