| NPI | 1437203429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 61668) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207X00000X Orthopaedic Surgery (Licence: MO 2015021378) | |
| 207X00000X Orthopaedic Surgery (Licence: WI 17977) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2023-10-12 |