| 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 |