| NPI | 1285899039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 34.011014) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101018880) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: LA DO.000294) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58002652) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2022-01-25 |