| NPI | 1336702224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME168209) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 30229) |
| 207X00000X Orthopaedic Surgery (Licence: MN 68395) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2025-03-21 |