| NPI | 1538310107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 8882) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: SD 8882) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MN 55102) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN11308) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2022-01-26 |