| NPI | 1679641609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 41148) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: KY 41148) |
| 207Q00000X Family Medicine (Licence: IN 01056257A) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2009-07-31 |