| NPI | 1063489318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 1671681) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME168712) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2026-03-10 |