| NPI | 1174516629 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: MO 107664) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 107664) | 
| Enumeration Date | 2005-08-30 | 
| Last Update Date | 2012-04-19 |