| NPI | 1144754169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: OH 35.148630) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2022-01050) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2023-08-21 |