| NPI | 1013479831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MN 76552) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME174138) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: WI 83912) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-06-25 |