| NPI | 1750797148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME145932) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT219207) |
| 207X00000X Orthopaedic Surgery (Licence: MO 2014022416) | |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2026-01-09 |