| NPI | 1518960640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 28616) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: TN 28616) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2022-05-19 |