| NPI | 1215391198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 316081) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 316081-01) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IN 01085555A) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 036.156646) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2024-03-14 |