| NPI | 1376076901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.149199) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME154601) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2023-10-08 |