| NPI | 1912497884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WA 61639878) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: OR MD215216) | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2026-04-23 |