| NPI | 1568995413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 62021) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WV 34290) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2026-07-15 |