| NPI | 1043499577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 56806) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.099051) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 45459) | |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2022-07-21 |