| NPI | 1952688392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME111506) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: FL ME111506) |
| 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: FL ME111506) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: FL ME111506) | |
| 207XX0801X Orthopaedic Surgery Orthopaedic Trauma (Licence: FL ME111506) | |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2019-01-31 |