| NPI | 1942620687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0106X Orthopaedic Surgery Hand Surgery (Licence: MN 68001) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 70878-20) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2021-03-12 |