| NPI | 1316174428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR0055411) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX BP10034019) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2014-0362) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2016-02-15 |