NPI | 1114456597 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2023022673) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-09234) |
Enumeration Date | 2017-06-08 |
Last Update Date | 2025-03-19 |