| NPI | 1316093180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD D0067412) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35-088976) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2013-11-13 |