| NPI | 1053610865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 60136) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA PGY.201227) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2021-05-27 |