| NPI | 1215964309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 6901924-1205) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NM 89-246) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-08-02 |