| NPI | 1144635319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: PR 21768) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PR 21768) |
| 207X00000X Orthopaedic Surgery (Licence: MA 282723) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2021-09-13 |