| NPI | 1841481975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX R7033) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: TX R7033) | |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: NE 25091) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2024-10-03 |