| NPI | 1154309029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI RS006845) |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: MI RS006845) |
| Enumeration Date | 2006-01-02 |
| Last Update Date | 2007-07-08 |