| NPI | 1407439920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 11463) |
| Additional Taxonomies | 171W00000X Contractor (Licence: GA 11463) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2024-09-19 |