| NPI | 1720231749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: NC 2013-01658) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35-095831) |
| 207X00000X Orthopaedic Surgery (Licence: KY 44010) | |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2021-10-05 |