| NPI | 1982109955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 57633) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 125.071748) |
| 208600000X Surgery (Licence: IL 125.071748) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2023-07-18 |