| NPI | 1578058665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX T7746) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A154951) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2022-09-07 |