| NPI | 1326458647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2024041771) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NH 20736) |
| 207X00000X Orthopaedic Surgery (Licence: TX T2209) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX T2209) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2025-03-17 |