| NPI | 1700853017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 063577) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD00041638) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WA MD00041638) | |
| Enumeration Date | 2006-03-06 |
| Last Update Date | 2014-02-07 |