| NPI | 1770902249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME145638) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A160870) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2023-09-19 |