| NPI | 1811914435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 20698) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: NC 20698) |
| 208D00000X General Practice (Licence: NC 20698) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: NC 20698) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-08-26 |