| NPI | 1437779840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.249794) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 341982) |
| Enumeration Date | 2020-04-26 |
| Last Update Date | 2026-06-27 |