| NPI | 1972160695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 82504) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME168244) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2025-09-09 |