| NPI | 1558930891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 1025812) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2026-07-27 |