| NPI | 1669636031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX N8617) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX N8617) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2015-03-12 |