| NPI | 1811150683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 81522) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101256117) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: VA 0101256117) | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: SC 82430) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10031380) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2023-06-27 |