| NPI | 1609239888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MN 70863) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101271989) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2025-11-03 |