| NPI | 1053015396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 64855) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 64856) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2023-03-29 |