| NPI | 1568610103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA MD-45200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004190) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2023-08-15 |