Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 15215 | CA |
NPI | 1881842342 |
---|---|
Provider Name | Dr. Michael Gorgas |
First Address | San Diego, CA 92121-3703 |
Second Address | San Diego, CA 92121-3703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2008 |
Last Update Date | 08/09/2008 |