| NPI | 1124221502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 48440) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 67672-20) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2020-08-13 |