| NPI | 1730624891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 312150) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL UO4394) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO4394) | |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2022-08-03 |