| NPI | 1396752259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H6465) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: TX H6465) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2018-05-01 |