| NPI | 1366820243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME156050) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO DR.0066534) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2022-10-25 |