| NPI | 1003870775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0073093) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: FL ME0073093) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2024-10-01 |