| NPI | 1639338890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD448570) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME151957) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09314500) | |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2021-11-03 |