| NPI | 1942514963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 10529A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58-003546) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2020-01-21 |