| NPI | 1255690996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 57969) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN 57390) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2020-09-18 |