| NPI | 1417510678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A194801) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: VA 0101285647) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2025-06-04 |