| NPI | 1770012882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 64065) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 81559) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2023-08-31 |