| NPI | 1861788077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A161885) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101254323) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101254323) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207X00000X Orthopaedic Surgery (Licence: WA MD61088562) | |
| 207X00000X Orthopaedic Surgery (Licence: CA A161885) | |
| 207X00000X Orthopaedic Surgery (Licence: FL ME136149) | |
| Enumeration Date | 2011-06-26 |
| Last Update Date | 2026-08-17 |