| NPI | 1295701662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E4682) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: TX E4682) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2011-06-20 |