| NPI | 1033375613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101252688) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35092601) |
| Enumeration Date | 2008-08-02 |
| Last Update Date | 2022-01-04 |