| NPI | 1730560319 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: ND 14011)  | 
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: MN 58945)  | 
| Enumeration Date | 2015-06-09 | 
| Last Update Date | 2020-06-08 |