| NPI | 1316056013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202C00000X Independent Medical Examiner (Licence: NY 099426) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 99421-1) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: CO DR.0052261) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2019-05-03 |