| NPI | 1164489761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 340185) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35082979S) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: SC 33999) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2026-03-06 |