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 |