| NPI | 1063523017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: NY 150901) |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: NJ 25MA06049900) |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: CT 47119) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-12-30 |