| NPI | 1609891654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: TN MD0000016758) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN MD016758) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-08 |