| NPI | 1487941910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME170880) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301099365) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2025-05-01 |