| NPI | 1346695988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 76420) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD61280033) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2026-02-05 |