| NPI | 1780004242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 65158) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ME MD23608) |
| 207XX0801X Orthopaedic Surgery Orthopaedic Trauma (Licence: MN 65158) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2023-10-13 |