| NPI | 1386144913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: HI MD-20733) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: HI MD-20733) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208D00000X General Practice (Licence: HI MD-20733) | |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2026-07-06 |