| NPI | 1700148731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 56351) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-07858) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME131765) | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2018-08-20 |