| NPI | 1891985024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 1871553297) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 021593) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 207XX0801X Orthopaedic Surgery Orthopaedic Trauma (Licence: GA 021593) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2009-11-30 |