| NPI | 1629531744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101286457) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207X00000X Orthopaedic Surgery (Licence: MN 30235) | |
| 207X00000X Orthopaedic Surgery (Licence: MN 67713) | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2025-10-22 |