| NPI | 1407086390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A109109) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CA A109109) |
| Enumeration Date | 2009-07-25 |
| Last Update Date | 2015-04-09 |