| NPI | 1164420733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KS 0416972) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 34572) |
| 207X00000X Orthopaedic Surgery (Licence: WI 46L39020) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2021-06-11 |