| NPI | 1780672105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 56088) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NH LT-3003) |
| 207X00000X Orthopaedic Surgery (Licence: ME MD19308) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2020-12-18 |