| NPI | 1780648691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0010022) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: VT 0420010022) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2024-04-16 |