| NPI | 1922441567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 73259) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 49708) |
| 208D00000X General Practice (Licence: MA 26834) | |
| Enumeration Date | 2013-04-13 |
| Last Update Date | 2023-10-20 |