| NPI | 1902136823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.132180) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60340423) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WA MD60340423) | |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2022-07-21 |