| NPI | 1780190264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NV DO3399) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: FL OS18711) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO5601) | |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2026-04-03 |