| NPI | 1407815343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 61804) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ID M-12226) |
| 207X00000X Orthopaedic Surgery (Licence: WA MD60912644) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2021-01-11 |