| NPI | 1649890732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: TX W5399) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX W5399) |
| 207X00000X Orthopaedic Surgery (Licence: OH 35.153326) | |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2026-06-02 |