| NPI | 1548433345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: OK 5494) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 390200000X) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: OH OH-9638) | |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2016-02-03 |