| NPI | 1164982518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MN 79232) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 250269) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2025-07-31 |