| NPI | 1730269341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AK 7100) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TN 27194) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2022-05-09 |