| NPI | 1255605218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: ME PA1320) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: ME PA1320) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ME PA1320) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: ME PA1320) | |
| 363A00000X Physician Assistant (Licence: ME PA1320) | |
| 363AS0400X Physician Assistant, Surgical (Licence: ME PA1320) | |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2024-12-30 |