| NPI | 1487217436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 67796) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MN 67796) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 67796) | |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2024-06-26 |