| NPI | 1982720231 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA 48358) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 53573) |
| 207X00000X Orthopaedic Surgery (Licence: OH 57-012100) | |
| 207X00000X Orthopaedic Surgery (Licence: WI 69507) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2023-07-17 |