| NPI | 1205217577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2026-03540) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL 2620) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AL 2620) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 86) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2026-03540) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2026-09-21 |