| NPI | 1699749333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9601299) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NC 9601299) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2016-01-15 |