NPI | 1962607200 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0054168) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 24038) |
207X00000X Orthopaedic Surgery (Licence: NE 24038) | |
Enumeration Date | 2007-06-18 |
Last Update Date | 2021-03-11 |