NPI | 1811458508 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: MN 79496) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101271902) |
208D00000X General Practice (Licence: VA 0101271902) | |
Enumeration Date | 2019-03-26 |
Last Update Date | 2025-07-30 |