| NPI | 1578760153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.139053) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.139053) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2026-05-05 |