| NPI | 1821085770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 027521) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA G15295) |
| 207X00000X Orthopaedic Surgery (Licence: TN 27521) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2014-05-20 |