| NPI | 1497164354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 301009) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NY 301009) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 275203) | |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2019-10-31 |