| NPI | 1598381642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: DE c1-0027478) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: DE c1-0027478) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2025-01-16 |