| NPI | 1821354705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2018-01423) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 077544) |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: GA 077544) | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-10-20 |