| NPI | 1700029196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX N9971) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: TX N9971) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2023-09-13 |