| NPI | 1811985575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ME 011833) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: ME 011833) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: ME 011833) | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2007-07-08 |