| NPI | 1912460999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101283148) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2024-01608) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2025-11-12 |