| NPI | 1477087997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 125.079170) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA S09100492) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2022-06-02 |