| NPI | 1790748630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME143456) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D0023376) |
| 207X00000X Orthopaedic Surgery (Licence: OH 35043193) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2020-07-20 |