NPI | 1386883643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: AL 8254) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL 8254) |
202C00000X Independent Medical Examiner (Licence: AL md8254) | |
Enumeration Date | 2009-02-10 |
Last Update Date | 2017-01-31 |