| NPI | 1770115719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA OL61089511) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: DC DO210012609) |
| 207X00000X Orthopaedic Surgery (Licence: MD H0103876) | |
| 208D00000X General Practice (Licence: NE 2543) | |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2025-06-13 |