| NPI | 1548720519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 68205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 29964) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2020-09-21 |