| NPI | 1710637590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 74704) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 32512) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2023-07-14 |