| NPI | 1740514116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 276765) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A141910) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MN 60338) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2021-12-14 |