| NPI | 1851503239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 209800000X Legal Medicine (Licence: CA G57663) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G57663) |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2025-09-11 |