| NPI | 1679101307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 60433) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 30790) |
| 207X00000X Orthopaedic Surgery (Licence: MN 71494) | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-07-11 |