| NPI | 1992268049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: SC 94391) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN 70545) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2025-05-21 |