| NPI | 1114181435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 274789) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI 14250) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: NY 274789) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2014-09-09 |