| NPI | 1659758613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 69197) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 69197) |
| 207X00000X Orthopaedic Surgery (Licence: WI 75757-20) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 75757-20) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2022-05-10 |