| NPI | 1184808677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX N6040) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OK 29485) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2021-01-21 |