| NPI | 1659765568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: AZ 63216) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 63216) |
| 2086X0206X Surgery Surgical Oncology (Licence: AZ 63216) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2024-03-01 |