| NPI | 1639558323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301111073) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 58715) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2020-04-22 |