| NPI | 1306147681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 05229) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11590) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207X00000X Orthopaedic Surgery (Licence: CA 20A17503) | |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2026-08-07 |