| NPI | 1699260687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: FL ME168673) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME168673) |
| 207X00000X Orthopaedic Surgery (Licence: PA MT228438) | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2024-07-16 |