| NPI | 1457705386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 6547620-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2019-00197) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2022-09-14 |