| NPI | 1356616692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101264068) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2018-01130) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME130036) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2021-04-23 |