| NPI | 1346449873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101251870) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI 13584) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101251870) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-14 |
| Last Update Date | 2020-10-21 |