| NPI | 1740451251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101252166) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.090778) |
| 207X00000X Orthopaedic Surgery (Licence: KY 44106) | |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2012-08-09 |