| NPI | 1134106354 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35058254) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: OH 35.058254CTR) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2025-02-10 |