| NPI | 1245588680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.139213) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2018016207) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2020-10-20 |