| NPI | 1083669204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5523050-1205) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: UT 5525050-1205) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2012-08-31 |