| NPI | 1902127525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A149214) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH none) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116029604) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2022-07-21 |