| NPI | 1255861365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME173313) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2024-0563) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2025-08-04 |