| NPI | 1013602507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 125.082727) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2024-05-20 |