| NPI | 1578902326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PR 21535) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME141750) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2020-06-04 |