| NPI | 1063708915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 10520) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 55491) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2016-00257) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2023-06-06 |