| NPI | 1023645587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 31144801) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-06-24 |