| NPI | 1568438331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 24587) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 50067-20) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2011-05-10 |