| NPI | 1215389879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MA 270980) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 270980) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT211720) | |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2019-07-03 |