| NPI | 1124413372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.142430) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301502061) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2023-11-03 |