| NPI | 1326049719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OK 32255) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35097758) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2016-07-08 |