| NPI | 1023339645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: MN 64946) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 26395) |
| 207X00000X Orthopaedic Surgery (Licence: ID M-15175) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2025-07-25 |