| NPI | 1063808806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M-15794) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207X00000X Orthopaedic Surgery (Licence: FL ME143798) | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2021-07-14 |