| NPI | 1306062385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202C00000X Independent Medical Examiner (Licence: NE 18589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 18589) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2012-08-01 |