| NPI | 1881614196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME64950) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 51620) |
| 207X00000X Orthopaedic Surgery (Licence: NY 186250) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-10-06 |