| NPI | 1588674097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N4398) |
| Additional Taxonomies | 209800000X Legal Medicine (Licence: WY 8692A) |
| 209800000X Legal Medicine (Licence: NV 13881) | |
| 209800000X Legal Medicine (Licence: MN 54098) | |
| 209800000X Legal Medicine (Licence: WI 49564-20) | |
| 209800000X Legal Medicine (Licence: MO 2011026836) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2011-08-17 |