| NPI | 1104289164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2022-00685) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 57.025421) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2022-09-21 |