| NPI | 1235719121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0077586) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.250949) |
| 207X00000X Orthopaedic Surgery (Licence: CO DR.0077586) | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2026-07-31 |