| NPI | 1063863843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 36059) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX R7358) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2025-12-08 |