| NPI | 1255861472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 80452) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101023375) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2025-08-21 |