| NPI | 1376549170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 32273) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL 37067) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME138683) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2021-04-06 |