| NPI | 1790027613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 71065) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101264672) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2025-07-17 |