| NPI | 1104815380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA C36056) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CA C36056) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2011-01-12 |