| NPI | 1548208028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5755327-1205) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: UT 5755327-1205) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2012-08-31 |