| NPI | 1942681101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 036.157676) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: LA 323567) | |
| Enumeration Date | 2015-06-13 |
| Last Update Date | 2023-03-11 |