| NPI | 1922425800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 5583016-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX 5583016-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2020-08-18 |