| NPI | 1407247331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX T2337) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA CA149425) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2023-03-08 |