| NPI | 1861835274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 11690682-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 63347) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2026-04-16 |