| NPI | 1962897934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME171594) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101271111) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2026-01-27 |