| NPI | 1104077064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME134460) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35095661) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME134460) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35095661) | |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2023-03-07 |