| NPI | 1376938043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101268214) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 57.026651) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2020-06-10 |