| NPI | 1164829750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 14624) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2014020638) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2023-08-28 |