| NPI | 1811552847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 83686-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2022-01435) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2024-06-27 |