| NPI | 1710330113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY TP213) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: OH 35.146094) |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: WV 28383) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2022-10-31 |