| NPI | 1215433305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 99384) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME160885) |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: FL ME160885) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2024-09-06 |