| NPI | 1760127880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 74650) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 32610) |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2023-07-12 |