| NPI | 1477917813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 71272) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 1477917813) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2023-03-15 |