| NPI | 1639342462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 75011) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 32296) |
| 207X00000X Orthopaedic Surgery (Licence: MN 57278) | |
| Enumeration Date | 2008-04-13 |
| Last Update Date | 2023-01-25 |