| NPI | 1477832517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM MD2014-0664) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 60558-20) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME121046) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2020-09-09 |