| NPI | 1124065420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TN MD21573) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD0000021573) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: TN MD0000021573) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2023-10-27 |