| NPI | 1699738799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME138251) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 037617) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2020-04-01 |