| NPI | 1073707816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: AL MD.32705) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 104272) |
| 363AS0400X Physician Assistant, Surgical (Licence: MN 104272) | |
| 207X00000X Orthopaedic Surgery (Licence: GA 064744) | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: GA 064744) | |
| 207X00000X Orthopaedic Surgery (Licence: AL MD.32705) | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2013-09-24 |