| NPI | 1992047872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 209800000X Legal Medicine (Licence: TX F2060) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX F2060) |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2013-03-19 |