| NPI | 1497049753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 290994) |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: CO 58325) |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2022-03-15 |