| NPI | 1639664378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 84820) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 84820) |
| 207X00000X Orthopaedic Surgery (Licence: TX V8383) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2025-09-20 |