| NPI | 1336598473 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME155921) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL TRN23506) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2022-11-22 |