| NPI | 1376744565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: CT 54330) |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: KY 02959) |
| 207X00000X Orthopaedic Surgery (Licence: KY 02959) | |
| 207X00000X Orthopaedic Surgery (Licence: NY 240996) | |
| 207X00000X Orthopaedic Surgery (Licence: CT 54330) | |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: NH 16410) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2015-07-01 |