| NPI | 1811077894 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WA MD00011315) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD00011315) | 
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: WA MD00011315) | |
| Enumeration Date | 2006-10-16 | 
| Last Update Date | 2011-09-28 |