| NPI | 1881897676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA 38867) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301083467) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301083467) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: IA 38867) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2013-08-05 |