| NPI | 1831332659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.128189) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME123050) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2016-07-15 |