| NPI | 1699979534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: FL ME 104463) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD429548) |
| 207X00000X Orthopaedic Surgery (Licence: PA MT184380) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2014-07-23 |