| NPI | 1871572834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: FL ME104124) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 2008-00954) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME104124) | |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: TX P8302) | |
| 207X00000X Orthopaedic Surgery (Licence: TX P8302) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2014-12-10 |