| NPI | 1902292964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 70688) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2021023186) |
| 207X00000X Orthopaedic Surgery (Licence: WI 81429-20) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2023-08-15 |