| NPI | 1972724755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.091821) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 41820) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 41820) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2024-04-11 |