| NPI | 1316236789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.130829) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2020-11-30 |