| NPI | 1306420021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2026-02006) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 93966) |
| Enumeration Date | 2021-05-09 |
| Last Update Date | 2026-07-08 |