NPI | 1861802019 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 67129) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2014-04-28 |
Last Update Date | 2020-07-16 |