| NPI | 1215933700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 34-00-3206) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WV 770) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2023-02-13 |