| NPI | 1346273661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: NY 221440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 221440) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2019-02-11 |