| NPI | 1780613935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 262412) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: FL ME0053894) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2015-10-19 |