| NPI | 1366598963 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WA MD60088076)  | 
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: CO 45319)  | 
| 207X00000X Orthopaedic Surgery (Licence: WA MD60088076)  | |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: WA MD60088076)  | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD60088076)  | |
| 208600000X Surgery (Licence: WA MD60088076)  | |
| Enumeration Date | 2007-01-26 | 
| Last Update Date | 2014-01-30 |