| NPI | 1952613630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101261998) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 26782) |
| 207X00000X Orthopaedic Surgery (Licence: KY TP425) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2019-06-04 |