| NPI | 1275209504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: CT 75586) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: RI LP05276) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 1.070524-RES) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2024-04-15 |