| 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 |