| NPI | 1053347898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14570) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: PR 14570) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2016-03-02 |