| NPI | 1730612565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX U2798) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME156288) |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2023-09-15 |