| NPI | 1194259960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101278009) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 227592) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2023-07-06 |