| NPI | 1619409562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2023-02413) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME154344) |
| 207X00000X Orthopaedic Surgery (Licence: SC 89648) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2023-10-05 |