| NPI | 1215152855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 17048) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CT 17048) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2011-01-13 |