| NPI | 1548606114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 57992) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA R-11077) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2020-09-29 |