| NPI | 1649559204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2023-00891) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 58.003960) |
| 207X00000X Orthopaedic Surgery (Licence: PA OS018227) | |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2024-06-27 |