| NPI | 1134112774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME122199) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 173877) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2014-11-20 |