| NPI | 1417377227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME138638) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX BP10050350) |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2019-06-27 |