| NPI | 1669890216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AK 158235) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60931360) |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: WA MD60931360) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2020-08-31 |