| NPI | 1316365653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 52868) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 52868) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2022-11-15 |