| NPI | 1932121423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 250859) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 36552) |
| 207X00000X Orthopaedic Surgery (Licence: ND 6204) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-03-31 |