| NPI | 1902046493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME110211) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2010-0018) |
| 207X00000X Orthopaedic Surgery (Licence: NY 246504) | |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2022-06-30 |