| NPI | 1386753895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 32898) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 56958) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-05-29 |