| NPI | 1790049013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101272652) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT202570) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME136492) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2022-10-06 |