| NPI | 1417339995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: MO 2021014672) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: IL 125.075413) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 7530) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2023-01-27 |