| NPI | 1538161872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35-038479) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ME 013782) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2009-12-21 |