| NPI | 1235517202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 85800) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MS 27245) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2023-01-05 |