| NPI | 1588649586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME78271) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35059268) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2020-07-10 |