| NPI | 1982609384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO R8470) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 0416043) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2011-02-16 |