| NPI | 1912971508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 029044) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD07302) |
| 207X00000X Orthopaedic Surgery (Licence: WV 22726) | |
| 207X00000X Orthopaedic Surgery (Licence: NC 2010-00313) | |
| 207X00000X Orthopaedic Surgery (Licence: ME TD131075) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2013-06-24 |