| NPI | 1578912226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NE 34813) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 6161) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA MD-51161) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT222281) | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2024-04-04 |