| NPI | 1073711677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TN 49850) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TN 49850) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2015-10-08 |