| NPI | 1962791251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA 206955) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME126476) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2024-04-11 |