| NPI | 1134482284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR 186916) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 56497) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2018-09-18 |