| NPI | 1235494105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207SG0201X Medical Genetics, Clinical Genetics (M.D.) (Licence: WA ML60566212) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT201870) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2015-07-02 |