| NPI | 1861070450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10076497) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME180054) |
| 207X00000X Orthopaedic Surgery (Licence: TX U9619) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2026-07-02 |