| NPI | 1538571609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX S5855) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 65095) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 94-08387) | |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2021-12-07 |