| NPI | 1811293053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: FL ME122073) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 261371) |
| Enumeration Date | 2011-02-06 |
| Last Update Date | 2016-06-01 |