| NPI | 1801963947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60050882) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC LL29501) |
| 207L00000X Anesthesiology (Licence: MI L1154431) | |
| 208D00000X General Practice (Licence: WA MD60050882) | |
| 202C00000X Independent Medical Examiner (Licence: WA MD60050882) | |
| 209800000X Legal Medicine (Licence: WA MD60050882) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2015-07-03 |