| NPI | 1629399829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: KS 0439665) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101252656) |
| 207X00000X Orthopaedic Surgery (Licence: TX S1387) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2020-01-31 |