| NPI | 1790059814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 007552) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX R3194) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2018-07-25 |