| NPI | 1164841136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61401603) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME139157) |
| 207X00000X Orthopaedic Surgery (Licence: NM MD2020-0582) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2024-12-12 |