| NPI | 1154571370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202C00000X Independent Medical Examiner (Licence: OH 35.038593) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: TX M6353) |
| 208D00000X General Practice (Licence: OH 35.038593) | |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2008-09-24 |