| NPI | 1669903233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: AL MD.46430) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2022-1221) |
| 207X00000X Orthopaedic Surgery (Licence: FL TRN24925) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2023-08-09 |