| NPI | 1205369857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ME MD26724) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: ME MD26724) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2025-11-21 |