| NPI | 1568879773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: AZ 67001) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 6867) |
| 207X00000X Orthopaedic Surgery (Licence: TX S7129) | |
| 207X00000X Orthopaedic Surgery (Licence: OR MD192929) | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: TX S7129) | |
| Enumeration Date | 2014-07-20 |
| Last Update Date | 2026-03-10 |