| NPI | 1992796684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: WV 25703) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WV 25703) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WV 25703) | |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: OH 35-098098) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2021-11-29 |