| NPI | 1194112151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KS 04-44686) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0064074) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2021023196) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2022-01-18 |