| NPI | 1477973063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 67347) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2019-00504) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2020-12-01 |