| NPI | 1154020873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 80533) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 34343) |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2025-11-06 |