| NPI | 1790164978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 286040) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 57025162) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2021-07-26 |