| NPI | 1790949667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301064984) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: MI 4301064984) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2023-10-12 |