| NPI | 1780682658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KS 04-23621) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO R9J25) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME74624) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2010-01-22 |