| NPI | 1174599732 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: KS 04-31950) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KS 04-31950) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2019-07-05 |