| NPI | 1720699523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 72184) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL16832) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2024-09-08 |