| NPI | 1215347117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 67925) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301116868) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2020-07-27 |