| NPI | 1295753127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX k7383) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: TX K7383) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2019-05-10 |