| NPI | 1770789570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202C00000X Independent Medical Examiner (Licence: LA 013131) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA MD.013132) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2019-09-25 |