NPI | 1457794299 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: KY 56674) |
Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: KY 56674) |
282N00000X General Acute Care Hospital (Licence: MO 2016022844) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-04-11 |
Last Update Date | 2022-09-20 |