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 |