| NPI | 1154783553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AZ 66093) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2021-1035) |
| 207X00000X Orthopaedic Surgery (Licence: UT 10491974-1205) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2023-03-17 |