| NPI | 1174903652 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME151901) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC LL38202) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2022-02-28 |