| NPI | 1356736144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME149333) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL TRN0021554) |
| 207X00000X Orthopaedic Surgery (Licence: SC 84000) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2022-01-05 |