| NPI | 1124237912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 55678) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301087573) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2013-07-18 |