| NPI | 1407582273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AL L.6590) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 62138) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: KY 62138) | |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2026-07-28 |