| NPI | 1558587204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 285114) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 221909) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 47491) | |
| 207X00000X Orthopaedic Surgery (Licence: OH 125140) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2016-07-28 |