| NPI | 1154983740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 76201) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5151014127) |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2024-08-20 |