| NPI | 1255412839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM 78-47) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NM 78-47) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2018-04-12 |