| NPI | 1770761355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI md14450) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: HI MD-14450) |
| 207Q00000X Family Medicine (Licence: OR md151178) | |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2021-07-19 |