| NPI | 1740150135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: VA 0110011378) |
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: VA 0110011378) |
| 363A00000X Physician Assistant (Licence: VA 0110011378) | |
| Enumeration Date | 2025-11-10 |
| Last Update Date | 2026-07-10 |