| NPI | 1801096987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: TX P2409) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT011703) |
| 207X00000X Orthopaedic Surgery (Licence: FL OS11195) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2014-10-16 |