| NPI | 1902260508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: TN 67337) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 008691) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2023-04-06 |