| NPI | 1003813619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: TX K4020) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K4020) |
| 208000000X Pediatrics (Licence: TX K4020) | |
| Enumeration Date | 2005-06-29 |
| Last Update Date | 2024-06-12 |