| NPI | 1972768232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI l1206639) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.001489) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0102202412) | |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2014-07-23 |