| NPI | 1104015148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 42924) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.095274) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2014-12-31 |