| NPI | 1760802136 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: OH 35.131773) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.131773) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2025-01-06 |