| NPI | 1790727253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME0055593) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA G89325) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2013-09-11 |