| 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 Service (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 |