| NPI | 1831272772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-11134) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: WA MD00034372) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2012-12-03 |