| NPI | 1992167712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME150724) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY R4205) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2021-06-04 |