| NPI | 1902221898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61273333) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WY 16951A) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WY 16951A) | |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2024-05-07 |