| NPI | 1942732029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME168979) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD19081) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2024-06-24 |