| NPI | 1477691061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 50477) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL me14909) |
| 207X00000X Orthopaedic Surgery (Licence: FL 19409) | |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2022-04-14 |