| NPI | 1124470109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: VA 0102207345) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA 016992) |
| 207X00000X Orthopaedic Surgery (Licence: FL OS17490) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2023-03-29 |