| NPI | 1497740849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PR 11039) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME131587) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2021-06-09 |