| NPI | 1063624948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MS 21555) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL MD.41536) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018373) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2021-04-05 |