| NPI | 1265473995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MI 4301078003) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35087017) |
| 207X00000X Orthopaedic Surgery (Licence: MI 4301078003) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2022-11-02 |