| NPI | 1063036572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.153707) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 35.153707) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2025-06-09 |