| NPI | 1952154593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: FL 9118522) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9118522) |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2025-11-18 |