| NPI | 1386900165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: RI MD16123) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63264) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2018-03-17 |