| NPI | 1922410430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 12750A) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: WY 12750A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT206863) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2022-10-31 |