| NPI | 1912981473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0003003) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: DE C10003003) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2021-05-18 |