| NPI | 1013449511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: PR 24417) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PR 24417) |
| 207X00000X Orthopaedic Surgery (Licence: MN 76741) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2025-10-06 |