| NPI | 1245658012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 70139) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 283448) |
| Enumeration Date | 2014-03-30 |
| Last Update Date | 2021-09-29 |