| NPI | 1174987580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 62586) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 04-46572) |
| 207X00000X Orthopaedic Surgery (Licence: MO 2022032016) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2025-03-27 |