| NPI | 1225245228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101245347) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116015792) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 41861) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2010-03-02 |