| NPI | 1740690775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 5151014126) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WV 3004) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2019-06-27 |