| NPI | 1720204555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202C00000X Independent Medical Examiner (Licence: WV 13133) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: KY 21964) |
| 202C00000X Independent Medical Examiner (Licence: MO 2005012335) | |
| 202C00000X Independent Medical Examiner (Licence: OH 35037538R) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-07-08 |