| NPI | 1316131790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 9033476-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 57-013271) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2021-08-10 |