| NPI | 1801416110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX V6124) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 125.076010) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2025-06-11 |