| NPI | 1760713259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202C00000X Independent Medical Examiner (Licence: KS 04-12598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-12598) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2010-01-22 |