| NPI | 1487641072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL 015053 - AAOS iD#) |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: FL MEFL0036117) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2007-07-08 |