| NPI | 1720053564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD00017428) |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: WA MD00017428) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2021-04-30 |