| NPI | 1407432842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 96978) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC 96978) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2026-08-07 |