| NPI | 1023004082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 20227) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.078449) |
| 207X00000X Orthopaedic Surgery (Licence: OH 78449) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2022-04-07 |