| NPI | 1083902324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA G25058) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: CA G25058) |
| 208D00000X General Practice (Licence: CA G25058) | |
| 209800000X Legal Medicine (Licence: CA G25058) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2016-05-13 |