| NPI | 1528562790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 317894) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A183408) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 64069) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2024-07-25 |