| NPI | 1396726550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 1935) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 34-00-7884A) |
| 207X00000X Orthopaedic Surgery (Licence: PA OS-010351-L) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2020-12-19 |