| NPI | 1306016845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 52515) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY TP635) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2021-01-26 |