| NPI | 1538129879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 88-177) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NM 88177) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2017-04-17 |