| NPI | 1184007460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX T5608) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 592921) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2022-07-15 |