| NPI | 1366659591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301109309) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 40760) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 116018135) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-10-22 |