| NPI | 1417337106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2025-0205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 261061) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2025-07-25 |