| NPI | 1992816615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS006017L) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: PA os-006017L) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-10-07 |