| NPI | 1447397799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 55071) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.096849) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1938) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2024-09-18 |