| NPI | 1255656229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 60768) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 0055049) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 60768) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2021-03-10 |