| NPI | 1679077531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 73394) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MN 73394) |
| 207X00000X Orthopaedic Surgery (Licence: KY R4834) | |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: MN 73394) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2023-05-01 |