| NPI | 1558758185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A171072) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 307107) |
| 207X00000X Orthopaedic Surgery (Licence: ME MD24260) | |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2025-04-18 |