| NPI | 1215517040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: UT 14277861-1205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207X00000X Orthopaedic Surgery (Licence: IL 125.077617) | |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2026-07-29 |