| NPI | 1508864208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KS 04-19966) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO R9G73) |
| 207X00000X Orthopaedic Surgery (Licence: WI 45976) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2010-01-22 |