| NPI | 1649408543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 59898) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101018311) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2020-09-17 |