| NPI | 1073558037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: FL ME147329) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35061781) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2022-09-05 |