| NPI | 1487180238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: MN 73099) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO TBD) |
| 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: IA R-12657) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-05-22 |