| NPI | 1528521754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 34.017234) |
| 208D00000X General Practice (Licence: NC 2020-03567) | |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2024-06-24 |