| NPI | 1346465010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 47960) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 61995) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A120409) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 61995) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2018-08-02 |