| NPI | 1700464005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 164673) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207X00000X Orthopaedic Surgery (Licence: CA A207811) | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2026-04-22 |