| NPI | 1003215153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AL DO.3664) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL PTH7265) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2024-06-27 |