| NPI | 1699748632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME141122) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 048503) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2020-06-10 |