| NPI | 1265744205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME126909) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2017016667) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2019-12-05 |