| NPI | 1881696136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 110898) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 30353) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2012-02-27 |