| NPI | 1174739288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G42408) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G42408) |
| 209800000X Legal Medicine (Licence: CA G42408) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2013-04-22 |