| NPI | 1427020627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 66128) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA R8898) |
| 363A00000X Physician Assistant (Licence: MN 9776) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2021-12-20 |