| NPI | 1104454172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 69779) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 30895) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2021-08-24 |