| NPI | 1659564094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME121285) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: FL ME121285) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: PR 019705) | |
| 208600000X Surgery (Licence: PR 11735-I) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2020-09-04 |