| NPI | 1376071134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 70671) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA R-10904) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2024-01-12 |