| NPI | 1235663857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 191395) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2022-0582) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2024-03-14 |