| NPI | 1386645505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 26767) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 26767) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: KY 26767) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2020-12-10 |