| NPI | 1659320422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 1537) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV 49520) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2023-03-14 |