| NPI | 1073075446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AZ 77425) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX 694737) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME167757) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 694737) | |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2025-08-13 |