| NPI | 1174968416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MT 73318) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY R3365) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2019-08-05 |