| NPI | 1043647324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 007654) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MB09860500) |
| 207X00000X Orthopaedic Surgery (Licence: TX R4011) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2021-03-10 |