NPI | 1104386267 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: MD D0103621) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: DC MD600004322) |
Enumeration Date | 2019-03-23 |
Last Update Date | 2025-08-12 |