| NPI | 1821162462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA PGY.2.LSUSHORSU) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ad9470826511246) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-11-20 |