| NPI | 1760445530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 154327) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME0087456) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2011-09-29 |