| NPI | 1336521053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 90521) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 007626) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101272571) | |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2026-03-30 |