| NPI | 1710551254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX W4832) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: TX W4832) | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2026-05-18 |