| NPI | 1518996073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 286753) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35086640) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2026-01-28 |