| NPI | 1245646983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 65557) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM A-2196-18) |
| 207X00000X Orthopaedic Surgery (Licence: WI 71348-21) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2019-08-05 |