| NPI | 1407081185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 59611) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO 53280) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 156695) | |
| Enumeration Date | 2009-05-25 |
| Last Update Date | 2015-09-14 |