| NPI | 1396206280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 68213) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 68213) |
| 207Q00000X Family Medicine (Licence: MN 30001) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2024-09-18 |