| NPI | 1033309695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME74352) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: FL ME74352) |
| 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: FL ME74352) | |
| 209800000X Legal Medicine (Licence: FL ME 74352) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2023-05-18 |