| NPI | 1770882920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: CT 69374) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A150363) |
| 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: AZ 56697) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-26 |
| Last Update Date | 2022-11-02 |