| 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 |