| NPI | 1144616459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 79435) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 34.014302) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2022-05-20 |