| NPI | 1518131549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 42077) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 42077) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2022-08-02 |