| NPI | 1942592613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 076441) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2016-00752) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2017-08-11 |