| NPI | 1902097231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA PGY.2.LSUNO-OSU) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA PGY.2.LSUNO-OSU) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2022-02-11 |