| NPI | 1003820234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 2606111205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35062570) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35062570) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-02-15 |