| NPI | 1174999296 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KS 04-42398) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD454616) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2019-09-23 |