| NPI | 1245597780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 51739) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207X00000X Orthopaedic Surgery (Licence: KY 51739) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IN 01078535A) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2019-04-17 |