| NPI | 1699304493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.153915) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.153915) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2025-07-22 |