| NPI | 1710900162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: GA 59432) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D64605) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-03-17 |