| NPI | 1861028565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 72061) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 31665) |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2026-06-04 |