| NPI | 1023451648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 12430A) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 63335) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2020-01-23 |