| NPI | 1871759522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 9055) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 51918) |
| 207X00000X Orthopaedic Surgery (Licence: MS 22563) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2023-01-16 |