| NPI | 1801867874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35-030674) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: LA L009935) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ MA21035) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 134480) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-11-05 |