| NPI | 1063459873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME0099159) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35087761) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2007-07-09 |