| NPI | 1962450775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 45054) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 100241) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2017-02-01 |