| NPI | 1912499385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NC 2024-01426) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL23-0138) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT215518) | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2024-07-19 |