| NPI | 1114381118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME137411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME137411) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2021-12-20 |