| NPI | 1518374644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 12307) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 60328) |
| 207X00000X Orthopaedic Surgery (Licence: NE 32965) | |
| 207X00000X Orthopaedic Surgery (Licence: IA MD-47819) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2025-12-10 |