| NPI | 1881998490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 03949) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: KY 03949) |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2016-07-07 |