| NPI | 1730591777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 12646) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CT 12646) |
| Enumeration Date | 2014-05-26 |
| Last Update Date | 2014-05-27 |