| NPI | 1659692929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MT 72252) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ND 14077) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2015-00189) | |
| 207X00000X Orthopaedic Surgery (Licence: MI 4301096367) | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: ND 14077) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2019-07-02 |