| NPI | 1518344092 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.134639) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WV 27732) |
| 207X00000X Orthopaedic Surgery (Licence: WV 27732) | |
| 207X00000X Orthopaedic Surgery (Licence: OH 35.134639) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2025-01-22 |