| NPI | 1003226440 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: TX R6130) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX R6130) | 
| Enumeration Date | 2014-05-07 | 
| Last Update Date | 2021-10-28 |