| NPI | 1659667012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME135326) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD442913) |
| 207X00000X Orthopaedic Surgery (Licence: GA 66490) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2018-07-02 |