| NPI | 1487071460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 65424) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A159891) |
| 207X00000X Orthopaedic Surgery (Licence: CO DR.0065424) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A159891) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2022-03-18 |