| NPI | 1710249107 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO DR.0067316)  | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 04-41070)  | 
| Enumeration Date | 2012-06-12 | 
| Last Update Date | 2021-09-02 |