| NPI | 1114297553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR FE 157361) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR FE153842) |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2012-05-14 |