| NPI | 1902434129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 4645) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 58.031508) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-08-18 |