| NPI | 1659418333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: FL ME106531) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD P19219) |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: PA MD437369) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2012-03-23 |