| NPI | 1124036645 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.089720) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.089720) |
| 207X00000X Orthopaedic Surgery (Licence: OR MD22134) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2025-01-06 |