| NPI | 1053360719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 74413-20) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 206897) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2023-03-02 |