| NPI | 1376750265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME98196) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME98196) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2019-05-21 |