| NPI | 1144609314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M15808) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A168110) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT208785) | |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2022-03-07 |