| NPI | 1578185203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL25-1185) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-10234) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2025-07-28 |