| NPI | 1124387881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: DC MD047348) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 269565) |
| 207X00000X Orthopaedic Surgery (Licence: TX R7558) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2019-05-30 |