| NPI | 1598769440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME105356) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD057331L) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2017-01-30 |