| NPI | 1629852660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: MI 4351057099) |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2026-07-10 |