| NPI | 1518498179 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: CA A159767)  | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A159767)  | 
| Enumeration Date | 2017-03-24 | 
| Last Update Date | 2023-10-02 |