| NPI | 1770011637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.145898.MIL) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2021-01329) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2023-03-09 |