| NPI | 1679960843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 55557) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.142196) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: KY TP012) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: IL 125.075367) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: OH 35.142196) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2023-04-13 |