| NPI | 1700223815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 278087) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD16243) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2023-11-02 |