| NPI | 1134689169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2025-01712) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 99298) |
| 207X00000X Orthopaedic Surgery (Licence: SC 94536) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-08-20 |