| NPI | 1104231059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0106X Orthopaedic Surgery, Hand Surgery (Licence: FL ME151535) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT206683) |
| Enumeration Date | 2014-06-29 |
| Last Update Date | 2026-01-12 |