| NPI | 1346794880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 341160) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY FT564) |
| Enumeration Date | 2016-08-13 |
| Last Update Date | 2026-02-09 |