| 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 |