| NPI | 1831604719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 209800000X Legal Medicine (Licence: GA EPP869) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2021-01-13 |