| NPI | 1154688208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 64391) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN .) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2024-01-08 |