| NPI | 1699110874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: TX S3755) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL 18382) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: FL ME142313) | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WI 69066-20) | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2019-11-05 |