| NPI | 1053722603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 304081) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A165522) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 304081) | |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2024-05-13 |