| NPI | 1225357668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OS018267) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101018654) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 03879) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 34.011686) | |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2021-09-10 |