| NPI | 1174593479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35074726) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35-074726) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 35504) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IN 01043563) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2020-07-14 |