| NPI | 1821557950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 80764) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2024-01741) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CT 80764) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-07-31 |