| NPI | 1508002726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: FL OS12609) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101020200) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 34.010495) | |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2018-03-17 |