| NPI | 1003812025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME34781) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: FL ME0034781) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2011-06-10 |