| NPI | 1538507991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 30162) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME143087) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2025-12-09 |