| NPI | 1245678085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 10683A) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OR 163025) |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: MN 63864) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2024-06-26 |