| NPI | 1265694194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2014-01150) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.121857) |
| 207X00000X Orthopaedic Surgery (Licence: MI 4301092915) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2022-04-25 |