| NPI | 1710982053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 36117) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 78581) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 36117) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2022-03-07 |