| NPI | 1710419015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 81171) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 05204) |
| 207X00000X Orthopaedic Surgery (Licence: OH 34013953) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2023-08-22 |