NPI | 1689092520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2017011921) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 04-40286) |
Enumeration Date | 2014-03-28 |
Last Update Date | 2021-10-28 |