| NPI | 1467410258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35046510) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WV 14610) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2024-01-15 |