| NPI | 1356978407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2025-01291) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 125.075757) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-07-10 |