| NPI | 1083105852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 13867755-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD19295) |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: UT 13867755-1205) | |
| Enumeration Date | 2018-05-28 |
| Last Update Date | 2024-04-25 |