| NPI | 1871053892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CO DR.0072605) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO DR.0072605) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2024-06-21 |