| NPI | 1063610335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS0005328) |
| Additional Taxonomies | 209800000X Legal Medicine (Licence: FL OS0005328) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2023-04-24 |