| NPI | 1265708168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 50338) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY R2958) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY R2958) | |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2026-01-20 |