| NPI | 1790289643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 308459) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64052) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2024-06-26 |