| NPI | 1134614019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MT 127303) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ND RL15177) |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2024-04-04 |