| NPI | 1578853867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX R3105) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM RS2011-0351) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2018-08-15 |