| NPI | 1013103811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301087789) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: MI 4301087789) |
| 209800000X Legal Medicine (Licence: MI 4301087789) | |
| 209800000X Legal Medicine (Licence: NM 79-166) | |
| 209800000X Legal Medicine (Licence: DC MD12109) | |
| Enumeration Date | 2007-09-15 |
| Last Update Date | 2014-11-01 |