| NPI | 1407235724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61156092) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 60704) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WA MD61156092) | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2021-08-19 |