| NPI | 1558746206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WA MD.MD.61542397) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME154605) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: OR FE222887) | |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2026-07-28 |