| NPI | 1629531744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 67713) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 30235) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2020-08-24 |