| NPI | 1295807725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 19164) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WV 19164) |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2024-04-05 |