| NPI | 1689668592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME113951) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 44074) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2015-05-06 |