| NPI | 1720244932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MS 23260) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 45479) |
| 207X00000X Orthopaedic Surgery (Licence: OH 35.099675) | |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2020-01-06 |