| NPI | 1104827799 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX K1257) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: TX K1257) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2020-11-09 |