| NPI | 1275772048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OS016545) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI DO00992) |
| 208D00000X General Practice (Licence: VA 0102202441) | |
| 207X00000X Orthopaedic Surgery (Licence: NH LT-3781) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2024-08-01 |