| NPI | 1760820989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: KY TP215) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 361168134) |
| 207X00000X Orthopaedic Surgery (Licence: WA OP61396249) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2026-08-26 |