| NPI | 1255199758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-12233) |
| Enumeration Date | 2024-03-08 |
| Last Update Date | 2025-06-07 |