| NPI | 1508902024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 54459) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 105690) |
| 207X00000X Orthopaedic Surgery (Licence: MD p21395) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2014-02-21 |