| NPI | 1225017122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 8428019) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NC 28019) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2018-05-11 |