| NPI | 1104409465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WA MD70090796) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD70090796) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2026-06-10 |