| NPI | 1912941089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.136629) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WV 29014) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2023-02-13 |