| NPI | 1326129461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO DR.0055441) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101018188) |
| 207X00000X Orthopaedic Surgery (Licence: OH 34.011200) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 008895-1) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-10-22 |