| NPI | 1205323482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND 21340) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207QS0010X Family Medicine, Sports Medicine (Licence: ND 21340) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ND 21340) | |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2026-05-13 |