| NPI | 1770564973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM MD20050463) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME0029458) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2008-04-14 |