| NPI | 1073075446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX 694737) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 694737) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2024-02-01 |