| NPI | 1730441924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.140523) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 62151) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD452394) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2022-07-21 |