| NPI | 1104022417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OK 25730) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery Orthopaedic Trauma (Licence: OK 25730) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: OK 25730) | |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2020-04-07 |