| NPI | 1205034832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NV 14735) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 45479) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: AZ 45479) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019853) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2018-10-09 |