| NPI | 1205979762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: OH 35-091389) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 230912) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2012-10-02 |