| NPI | 1912389974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2025038859) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301503918) |
| 207X00000X Orthopaedic Surgery (Licence: IL 125.067589) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2025-10-28 |