| NPI | 1912157751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME115322) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: PA MD434449) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: FL ME115322) | |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2022-01-20 |