| NPI | 1376903732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 57270) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 30374) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2024-10-15 |