| NPI | 1114919982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 105477) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 04-23383) |
| 207X00000X Orthopaedic Surgery (Licence: MO 105477) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2018-03-17 |