| NPI | 1063775039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: FL ME132829) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 390200000) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2021-04-14 |