| NPI | 1215557582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 331406) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: FL OS19841) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 331406) | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2024-11-25 |