| NPI | 1861497117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KS 0523678) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO R3P93) |
| 207X00000X Orthopaedic Surgery (Licence: OK 2670) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2012-01-09 |