| NPI | 1104656800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351055231) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL L.6376F) |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2025-07-01 |