| NPI | 1255793527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY R4133) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY R4133) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2022-07-14 |