| NPI | 1588643290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 23941) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CO 29341) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2019-08-01 |