| NPI | 1487107090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: VA 0101284777) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101284777) | |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101284777) | |
| Enumeration Date | 2016-07-31 |
| Last Update Date | 2025-09-05 |