| NPI | 1679989396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: WA MD61286038) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD61286038) |
| 207X00000X Orthopaedic Surgery (Licence: MN 59423) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2022-06-07 |