| NPI | 1114211794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC FP6094560) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2016-00970) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 173014) | |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2018-08-28 |