| NPI | 1063857753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME139218) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 51035) |
| 207XS0117X Orthopaedic Surgery Orthopaedic Surgery of the Spine (Licence: KY 51035) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2019-08-02 |