| NPI | 1972040681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: CA 20A19599) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO4862) |
| 207X00000X Orthopaedic Surgery (Licence: FL UO4862) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2022-07-18 |