| NPI | 1639100506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2006-00120) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 86251) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: NC 200600120) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2021-08-27 |