| NPI | 1558800045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0116039182) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126003555) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2025-05-24 |