| NPI | 1477948941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 69005) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD467519) |
| 207X00000X Orthopaedic Surgery (Licence: WI 76382) | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2024-01-16 |