| NPI | 1104822436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME70240) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: FL ME0070240) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2011-06-10 |