| NPI | 1487675930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 51563) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: HI 4814) |
| 207X00000X Orthopaedic Surgery (Licence: WA 22642) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2018-05-19 |