| NPI | 1508253998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 69456) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 282565) |
| 207X00000X Orthopaedic Surgery (Licence: CT 69456) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2022-02-03 |