| NPI | 1770574212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 12032) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 56741) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD037652E) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2008-09-29 |