| NPI | 1013400605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND PT21417) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ND RL15152) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2024-09-13 |