| NPI | 1952862757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 78662) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 58.030590) |
| 207X00000X Orthopaedic Surgery (Licence: CO DR.0072619) | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-05-29 |