| NPI | 1407174584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 32870) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 0000000000000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2021-10-21 |