| NPI | 1184949505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX R9066) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2015-00024) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101259323) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2019-08-19 |