| NPI | 1447769864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL UO4863) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: UO4863) |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2022-07-26 |