| NPI | 1154783835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0102207011) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 34.013151) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-01-24 |