| NPI | 1568509198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 28528) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: AL 28528) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2023-04-12 |