| NPI | 1710272042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 61254) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA R-9196) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2022-07-21 |