| NPI | 1144611005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 29495) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207X00000X Orthopaedic Surgery (Licence: KY 57205) | |
| 207X00000X Orthopaedic Surgery (Licence: PA MD492508) | |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2026-06-12 |