| NPI | 1194037713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TN 2919) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101018980) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 5096) | |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2018-02-02 |