| NPI | 1700347606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD D0106514) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 279864) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.257839) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2026-04-07 |