| NPI | 1376303693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 80320) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 34427) |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2025-09-02 |