| NPI | 1679036347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 80566) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD61521442) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MN 80566) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-08-22 |