| NPI | 1568758134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: TX Q7383) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT200505) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2021-12-06 |