| NPI | 1932177821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IN 01077727A) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IN 11016098A) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36001278A) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OH AT 002474) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 48987) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2024-01-29 |