| NPI | 1245779636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: OH 34.016389) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: LA 331599) | |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2024-04-17 |