| NPI | 1972659183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME133499) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.089154) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2020-08-25 |