| NPI | 1639321615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35122917) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 57.015220) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2021-06-21 |