| NPI | 1245460013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA MD208009) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2014-00216) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10033781) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2023-08-18 |