| NPI | 1467403279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35087210) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY TP803) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-05-04 |