| NPI | 1407044522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 209800000X Legal Medicine (Licence: LA 10204R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 168114) |
| 209800000X Legal Medicine (Licence: NY 168114) | |
| 207R00000X Internal Medicine (Licence: LA 10204R) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2017-01-31 |