| NPI | 1881806834 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: AZ 45261) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A83999) | 
| Enumeration Date | 2007-05-03 | 
| Last Update Date | 2022-05-04 |