| NPI | 1487213542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 76332) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 76143) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351045456) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2025-07-14 |