| NPI | 1629502984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 96681) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 71398) |
| 207X00000X Orthopaedic Surgery (Licence: WI 22832) | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2024-01-23 |