| NPI | 1285070474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OT017816) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ID O-0808) |
| 208D00000X General Practice (Licence: ID O-0808) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2022-07-15 |