| NPI | 1295234391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A201646) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX W5955) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: TX W5955) | |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2026-06-12 |