| NPI | 1902489941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 06295) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2026-04-09 |