| NPI | 1124009774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.085533) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 25970) |
| 207X00000X Orthopaedic Surgery (Licence: WV 24025) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2017-05-04 |