| NPI | 1205356482 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 72278-20) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX U7025) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-20 | 
| Last Update Date | 2025-08-20 |