| NPI | 1407045602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301082055) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 57.012616) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: MI NP082055) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2020-12-03 |