| NPI | 1639327315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA A114098) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A114098) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P65752) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10035982) | |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2021-05-17 |