| NPI | 1003884966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101052855) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: VA 0101052855) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2010-07-23 |