| NPI | 1912904053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: TX G4110) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G4110) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2024-08-06 |