| NPI | 1841653813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301507691) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MI 4301507691) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2022-09-23 |