| NPI | 1154532646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 25876) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301089903) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301089903) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2022-04-05 |