| NPI | 1558948950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116041963) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 12952610-1205) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-06-18 |