| NPI | 1639143027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 108292) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 122354) |
| 207X00000X Orthopaedic Surgery (Licence: CT 034854) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2015-06-25 |