| NPI | 1245249697 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: GA 076810)  | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 076810)  | 
| 207X00000X Orthopaedic Surgery (Licence: WI 56764-20)  | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-08-05 | 
| Last Update Date | 2020-10-15 |