| NPI | 1730189408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K5963) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: TX K5963) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2011-05-03 |