| NPI | 1083145924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME163907) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2022-01092) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-10-23 |