| NPI | 1104440254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MN 79780) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX W6711) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX W6711) | |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2026-07-20 |