| NPI | 1023498177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301505034) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351041095) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2021-07-27 |