| NPI | 1982225579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2026-02788) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 261467) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116040797) | |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2026-08-13 |