| NPI | 1609133107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 74930) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 74930) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA MD-44763) | |
| 207X00000X Orthopaedic Surgery (Licence: IA MD-44763) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2025-09-11 |