| NPI | 1235395153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME141139) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 43566) |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2020-10-27 |