| NPI | 1285677567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL me0048128) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: FL 48128) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-01-29 |