| NPI | 1629393541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 65999) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A140625) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MN 65999) | |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX R2717) | |
| Enumeration Date | 2010-04-03 |
| Last Update Date | 2019-08-08 |