| NPI | 1629057336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 7923284) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NC 23284) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2023-03-07 |