| NPI | 1184087959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: KY 56988) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL 42665) |
| 207X00000X Orthopaedic Surgery (Licence: KY 56988) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2022-08-31 |