| NPI | 1538367453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202C00000X Independent Medical Examiner (Licence: FL os3676) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os3676) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2007-07-08 |